Marisa Emma Ford-Mimms

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

305728-1 Issued in NY

Practice address

9 Reservoir Rd
Tawling, NY 12564

Phone

(845) 855-5700

NPI assigned

Jul 23, 2013

Last updated

Jul 23, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Marisa Emma Ford Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1073955704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 DAVIS ST.",
            "address_2": "APT. 2",
            "city": "BEACON",
            "state": "NY",
            "postal_code": "12508",
            "telephone_number": "845-549-9982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 RESERVOIR RD",
            "city": "TAWLING",
            "state": "NY",
            "postal_code": "12564",
            "telephone_number": "845-855-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD-MIMMS",
        "first_name": "MARISA",
        "middle_name": "EMMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-23",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "305728-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "FORD",
            "middle_name": "EMMA",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.